Provider First Line Business Practice Location Address:
605 W HWY 82
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLOWA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97885-7114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-426-4502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2023